Healthcare Provider Details

I. General information

NPI: 1649378084
Provider Name (Legal Business Name): BALBIR S. BRAR, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23861 MCBEAN PKWY SUITE D16
VALENCIA CA
91355
US

IV. Provider business mailing address

P.O.BOX 55283
VALENCIA CA
91385-0283
US

V. Phone/Fax

Practice location:
  • Phone: 661-253-3008
  • Fax:
Mailing address:
  • Phone: 661-253-3008
  • Fax: 661-253-1448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BALBIR S. BRAR
Title or Position: DIRECT OWNER
Credential: M.D.
Phone: 661-253-3008